Nelson D W, Duwelius P J
Department of Diagnostic Radiology, Oregon Health Sciences University, Portland 97201.
Radiology. 1991 Aug;180(2):527-32. doi: 10.1148/radiology.180.2.2068323.
Open reduction and internal fixation (ORIF), the currently preferred method for treatment of unstable posterior pelvic and sacral fractures, has two significant disadvantages: the need for blind placement of the fixation screws and the occurrence of high complication rates. Advantages of computed tomographic (CT)-guided sacral fixation include direct visualization of the course of the screws and absence of significant complications. Eight patients with unstable but reducible sacral fractures or sacroiliac joint (SIJ) disruptions (seven unilateral and one bilateral) underwent CT-guided sacral fixation with use of the standard orthopedic A-O, 7.0-mm-diameter cannulated screw system. The guide pin was positioned across the fracture or SIJ by using depth and angulation measurements derived from the scout CT scans. After confirmation of the position of the pin with CT, the screw tract was drilled, and the cannulated screw was placed into position. Radiographic and clinical follow-up (5-9 months) showed healing with no significant complications in all eight patients. CT-guided sacral fixation is a safe alternative to ORIF in patients with reducible unstable pelvic fractures.
切开复位内固定术（ORIF）是目前治疗不稳定型骨盆后环及骶骨骨折的首选方法，但存在两个显著缺点：需要盲目置入固定螺钉以及并发症发生率高。计算机断层扫描（CT）引导下的骶骨固定术的优点包括可直接观察螺钉走行且无明显并发症。8例不稳定但可复位的骶骨骨折或骶髂关节（SIJ）脱位患者（7例单侧，1例双侧）接受了CT引导下的骶骨固定术，使用标准的骨科AO 7.0毫米直径空心螺钉系统。通过利用定位扫描CT扫描得出的深度和角度测量值，将导针穿过骨折部位或骶髂关节。经CT确认导针位置后，钻出螺钉通道，然后置入空心螺钉。影像学和临床随访（5 - 9个月）显示，所有8例患者均愈合且无明显并发症。对于可复位的不稳定骨盆骨折患者，CT引导下的骶骨固定术是切开复位内固定术的一种安全替代方法。
